Kid's Club and Youth Registration (2022-2023 School Year)

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Please register your child or youth so that we have the most up to date information to keep your student safe. We need to be able to contact parents/guardians if there is an emergency. We also like to keep in contact with you to let your student and family know what is happening at Full Gospel Church.

Student First Name *

Student Last Name *

Male/Female *

Grade *

Address *

City *

Birthdate *

(Please enter the month, day and year of your birth, in case of medical emergency) Example: 01/01/1998

Parent/Guardian First and Last Name *

Parent/Guardian phone *

What is the best phone number to reach your emergency contact?

Parent/Guardian Email

So that we may contact you regarding future kid/youth events and happenings at Full Gospel Church.

Student Medical Info

Allergies? Medications? Past medical history? Activity limitations? Dietary restrictions?

Any other information that we may need to know?

Photograph Release: I grant Full Gospel Church the right to take photographs of me and my family in connection with the above identified event.

Yes, I agree to the photo release

No, Please do not use photo's of me and my family. (If you or your family is in a group picture, we will not use it for publicity or web content.)

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